Care Redesigned for a New Age

By pioneering the concept of a department store that sells high-quality, ready-to-wear clothing, John Wanamaker turned shopping, as PBS puts it, “into an event for ordinary people.” Before him, shoppers cobbled together wardrobes from separately purchased component parts: cloth, buttons, ribbons, and labor. But Wanamaker didn’t just transform how clothes were made — he also revolutionized pricing. Instead of accepting that salespeople must haggle as they gauge what customers will pay against what the craftsman can charge, Wanamaker standardized pricing and made it visible to consumers, simplified the retail experience, and introduced fairness into the process. Our retail economy has never looked back.

Roughly a century later, the time has come for the same thinking to gain currency in the health industry. In short, care must be redesigned. We need to link together the components of care into a value stream, simplify how we provide and pay for services, and make the entire care trajectory transparent. New ways of thinking and behaving are hitting medicine at full steam, bolstered by advances in technology. Regulation and payment models are lagging behind, but their slow evolution cannot stop the onslaught of change.

Health care consumers are now empowered with access to online information about medical opinions, treatment options, and outcomes (although curation is spotty). Start-up companies are helping to make sense of the mess that has characterized health care pricing historically — no provider is proud of its chargemaster. Shouldn’t you be able to compare prices and outcomes wisely as you shop for your next colonoscopy? Don’t you want to find someone who can talk to you about your health and your values without recommending more (or less) treatment than you need? Maybe there will be an app for that.

The future lies in a technologically savvy system of care that is redesigned to be simple, customized, and affordable. After all, that’s what people really want. I have a basic test for innovations: Do they offer affordable care that is more personalized and more convenient? (See illustration.) In short, we need care that is driven by patient goals, not just the wisdom of experts, and that moves us out of brick-and-mortar structures into the places where people live, work, play, and pray.

Take prostate-cancer treatment, for example. We’ve moved from relying on individual providers’ expertise to embracing evidence-based guidelines and shared decision making about treatment options. We must now ask the patient what outcomes matter most: longevity, continence, sexual potency, and so on. And we can aim to improve outcomes and convenience with at-home tools for medication adherence, vital-sign and activity tracking, and (soon) lab monitoring.

The past century in medicine has been scientifically miraculous, but the focus on “curing” has often overlooked two other patient-centered values: caring for the whole person (physically, emotionally, socially, financially) and simplifying the care trajectory through care coordination. Technology, innovation, transparency, and patient empowerment are helping us rediscover our roots — as providers who aim to improve people’s lives. New systems of care, redesigned with the help of technology, can get us there, one customized experience at a time.

Discuss

Hans Duvefelt, MD

I hope you are right and this is the path towards a better future in medicine. But the forces that are driving the current system are not just going to roll over and play dead. I have written a commentary on my blog:
https://acountrydoctorwrites.wordpress.com/2015/12/11/this-is-america-you-dont-have-to-do-anything/

To more effectively treat the problems of obesity and diet-related conditions, health systems need to restructure the traditional medical model of care delivery to address the social determinants of health.